1983, 09-26 Permit: 83A-9515 Enclose DeckPLAN NUMBER APPLICATION/PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES —PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS PARCEL NO.
1. S - �v i'? 1MA2 t A W",
LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. 8 *;-_-cr;cz6---v
OWNER PHONE PHONE
,3A MCsLJJ L AvwS X4-jr2-Ci. :-2-
3. MAILING ADDRESS
ZIP
Actual Set Backs in Feet to: 6 �r t �'1 iA)Lt
lJ • R 1 1 A rV„
North I South East
I West
CONTRACTOR
LICENSE EXPIRES
Size of�l
Zone ClassificationF
Ca
-PHHOONE _�
Reid�al ❑
4.
ADDRESS
ZIP
T�,gnst. Occupancy
Sprinklered
�{3 17 �laSxar+.G
./
-g6kXa4
3
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
Const. Valuation
Remodeled Valuation
Total Bldg. Floor Area
7O
ADDRESS
ZIP
Main Floor Upper
Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
s.
TYPE
No. Baths No.
Floors
No. Fin. Rooms
No. Dwellings
El EW ALT. ElAD' N. El RPL. 11MVE.
7 ❑OTHER
WORK 'J oLD. ❑ PLMB. E3MECH. ElM.H. El POOL
�Ifi.ofExempt.
Required
Yes❑ No❑
Number
or Variance
Received
Yes❑ No❑
8 DESCRIBE WO K
Shorelines/ Flood Hazard
Plans Required b %
`
E IV X lSZ (N "1 �� C— OQC4L 6'Art i;;
Yes❑ Not Applic. ❑
Received l.Y
VALUATION
9•
I SOURCE
GAS
ELECTRIC
PUBLIC O
SEWAGE
1
Ownership /
�(
FEES COLLECTED
UTILITIES
PRIVATE ❑
SEWER ❑
Public ❑ Private
I hereby certify that I have read and examined this application and have read the "NOTICE"
provisions included on
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
S4 �
work will be complied with whether specified herein or not. The granting of a permit
p p g g p
does not resume to
p give au-
Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR EOUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
Mech.
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
N
Planning
Fire
Prevent.
Utilities
Plans PERMIT IS NONTRANSFERABLE
Exam. PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
Tuilh ing IN 180 DAYS
Plan Check
SEPA
Modular/
MFG.Home
Other (Specify)
PERMIT NUMBER
A'q.5i5
TOTAL $�
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PPERMIT.
DA4S2 ' — PERMIT/N�.1. 5 z * 5 4. 0 0 0AL
U